APA Releases New Report: Abortion No Threat to Women’s Mental Health

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Women's Health Activist Newsletter
September/October 2008

By Rachel Walden

The American Psychological Association (APA) has just released a report indicating that there is no solid scientific evidence that abortion causes mental distress in women.1 This is a timely refutation of the fiction, promoted by anti-choice activists for several decades, that having an abortion harms women’s mental health. The National Right to Life Committee (NRLC), for example, claims that, “Researchers on the after-effects of abortion have identified a pattern of psychological problems known as Post-Abortion Syndrome (PAS). Women suffering PAS may experience drug and alcohol abuse, personal relationship disorders, sexual dysfunction, repeated abortions, communications difficulties, damaged self-esteem, and even attempt suicide.”2 (To support this dire assertion, the NRLC only cites 20-year-old Congressional testimony.)

Trying to create a link between abortion and negative mental health outcomes appeals to anti-choice activists because it “challenges the connection between access to abortion and women’s rights.”3 To advance the strategy, anti-choice activists attempt to force women who are seeking abortions to receive misinformation about the procedure’s outcomes. They’re succeeding, too. An Eighth Circuit Court of Appeals decision recently upheld a 2005 South Dakota law that required pre-abortion counseling to describe “significant risk factors to which the pregnant woman would be subjected”, including depression, related psychological distress, and increased risk of suicidal ideation and suicide.4 Laws like this are called “biased counseling laws”, because women are forced to hear about potential adverse effects that are not supported by any available scientific evidence.5

The APA’s new document, Report of the APA Task Force on Mental Health and Abortion, traces this debate to 1987, when President Reagan “directed then-Surgeon General C. Everett Koop to prepare a Surgeon General’s report on the public health effects (both psychological and physical) of abortion.”6 Despite being an evangelical Christian who personally opposed abortion, Dr. Koop was reportedly reluctant to involve his office in what he saw as an attempt to appease the conservative political base. He ultimately issued not a report, but a letter to the President, revealing the outcome of his “vigorous” review of the available evidence, stating “the scientific studies do not provide conclusive data about the health effects of abortion on women. …[A]t this time the available scientific evidence about the psychological sequelae [effects] of abortion simply cannot support either the preconceived beliefs of those pro-life or those pro-choice.”7

At the time, the APA reviewed the evidence and concluded: “the best available studies on psychological responses following legal, nonrestrictive abortion in the United States suggest that severe negative reactions are infrequent. Some individual women may experience severe distress or psychopathology following abortion, but it is not clear whether these are causally linked to the abortion.”8

Now, almost 20 years later, the APA has reviewed the evidence again, and come to much the same conclusion. The organization’s Task Force on Mental Health and Abortion examined the English-language peer-reviewed studies on this topic that were published from 1989 to the present (earlier literature had already been analyzed for the previous review). The overall finding? “There is no credible evidence that a single elective abortion of an unwanted pregnancy in and of itself causes mental health problems for adult women.” While the report and conclusions focus primarily on single abortions, the APA noted that some associations between poorer mental health and multiple abortions have been observed. However, the authors caution that this “also may be due to co-occurring risks that predispose a woman to both unwanted pregnancies and mental health problems.”

The reviewers didn’t discount that some women may experience negative emotional outcomes after abortion -- they simply found that the evidence was insufficient “to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.” The reviewers noted that the fact that many of the studies were not well-designed, which limited the pool of reliable evidence. For example, some authors inappropriately confused correlation and causation: “Frequently, significant correlations observed between abortion history and other variables (e.g., substance abuse, depression, higher educational outcomes) were misinterpreted as evidence that abortion caused these variables to occur. Such causal claims are unwarranted, as the relationships may be spurious, the causal direction may be reversed, or the relationship may be due to a third variable that is associated with both abortion and the outcome variable (e.g., poverty).” In short, women may have been more likely to experience negative outcomes after abortion if they were already having economic or mental health problems before the procedure.

The APA further explains that “interpersonal concerns, including feelings of stigma, perceived need for secrecy, exposure to antiabortion picketing, and low perceived or anticipated social support for the abortion decision, negatively affected women’s postabortion psychological experiences.” In other words, anti-abortion tactics and the climate they create may negatively affect women’s mental health.

Rachel R Walden, MLIS is a medical librarian and blogger for Women's Health News and Our Bodies Our Blog.

REFERENCES

1. APA Task Force on Mental Health and Abortion, Report of the APA Task Force on Mental Health and Abortion, Washington, D.C.: American Psychological Association, 2008 p. 5-6. Available online at: http://www.apa.org/releases/abortion-report.pdf, accessed 9/8/08.

2. National Right to Life Committee (NRLC), Abortion: Some Medical Facts, Washington, DC: NRLC, no date. Online at: http://www.nrlc.org/abortion/ASMF/asmf14.html, accessed 9/8/08.

3. Bazelon E, “Is There a Post-Abortion Syndrome?”, The New York Times, 1/21/07, p. 2. Online at: http://www.nytimes.com/2007/01/21/magazine/21abortion.t.html, accessed 9/8/08.

4. The decision is available online at: http://www.ca8.uscourts.gov/opndir/08/06/053093P.pdf

5. Guttmacher Institute, State Policies in Brief: Counseling and Waiting Periods for Abortion, New York: The Institute, September 1 2008, p. 1. Online at: http://www.guttmacher.org/statecenter, accessed 9/8/08.

6. U.S. National Library of Medicine (NLM), Profiles in Science -- The C. Everett Koop Papers: Reproduction and Family Health, Bethesda, MD: NLM, no date. Online at: http://profiles.nlm.nih.gov/QQ/Views/Exhibit/narrative/abortion.html, accessed 9/8/08.

7. Specter M, “Koop Won't Issue Report on Abortion; Studies of Effects Called Inconclusive”, The Washington Post, 1/10/89. Accessed via Lexis Nexis.

8. Adler NE, David HP, Major BN et al, “Psychological factors in abortion: A review”, Am Psychol 1992; Oct;47(10):1194-204.

9. APA, “Press Release: APA Task Force Finds Single Abortion Not a Threat to Women's Mental Health”, Washington, DC: APA, 8/12/2008. Online at: http://www.apa.org/releases/abortion-report.html, accessed 9/8/08.